RESUMO
The aim of the present study was to evaluate the prevalence and impact of malocclusion on oral health-related quality of life (OHRQoL) among schoolchildren aged 8 to 10 years and their parents in Diamantina, a town in the southeast of Brazil. A cross-sectional study was conducted with a sample of 390 randomly selected children who were subjected to a clinical oral examination. The Dental Aesthetic Index was used to diagnose malocclusion and the need for orthodontic treatment. The Child Perceptions Questionnaire (CPQ (8-10)) was used to evaluate the impact of malocclusion on OHRQoL. The children's parents answered the Brazilian Economic Criterion Questionnaire for the socioeconomic classification. Data analysis involved the nonparametric Kruskal-Wallis test and Spearman's correlation coefficients. The variables were grouped into a hierarchy of categories ranging from distal to proximal determinants. Poisson regression analysis with robust variance was performed at each level to correlate the total CPQ (8-10) score with the independent variables. The prevalence of malocclusion was 78.7%. Crossbite remained significantly associated with a negative impact on OHRQoL (PR = 1.28; 95%CI:1.17-1.39; p < 0.001). The prevalence of malocclusion was high in the sample investigated and exerted a negative impact on OHRQoL.
Assuntos
Má Oclusão/epidemiologia , Má Oclusão/fisiopatologia , Saúde Bucal/estatística & dados numéricos , Qualidade de Vida , Brasil/epidemiologia , Criança , Estudos Transversais , Cárie Dentária/epidemiologia , Cárie Dentária/fisiopatologia , Estética Dentária , Feminino , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Masculino , Prevalência , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estatísticas não Paramétricas , Inquéritos e QuestionáriosAssuntos
Extubação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Brasil , Feminino , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics. METHODS: A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/ or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis. RESULTS: 78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis. CONCLUSIONS: Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
Assuntos
Faringite/diagnóstico , Faringite/microbiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Avaliação de Sintomas , Tonsilite/diagnóstico , Tonsilite/microbiologiaRESUMO
OBJECTIVE: To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics. METHODS: A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis. RESULTS: 78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis. CONCLUSIONS: Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis...
OBJETIVO: Avaliar a utilidade do quadro clínico para o diagnóstico da faringoamigdalite estreptocócica na faixa pediátrica. MÉTODOS: 335 indivíduos de 1 a 18 anos com quadro clínico de faringoamigdalite foram submetidos a anamnese, exame clínico, cultura e teste de aglutinação de partículas do látex (TAPL) para o estreptoco β-hemolítico do grupo A (EBHGA) em swab orofaríngeo. Os sinais e sintomas foram comparados ao resultado da cultura e do TAPL e, em seguida, também o foi o agrupamento de sinais e sintomas definido por regressão logística multivariada, utilizado para gerar um escore clínico. Para o diagnóstico definitivo de faringoamigdalite estreptocócica, o padrão de referência foi a cultura e o TAPL, em paralelo. RESULTADOS: 78 indivíduos (23,4%) apresentaram resultados positivos para EBHGA em pelo menos um dos testes. Ausência de coriza (OR=1,80; p=0,04); ausência de conjuntivite (OR=2,44; p=0,029); hiperemia de orofaringe (OR=3,99; p=0,006); exsudato de orofaringe (OR=2,02; p=0,011) e hipertrofia de amígdalas (OR=2,60; p=0,007) apresentaram associação significante com a faringoamigdalite estreptocócica. A pontuação máxima no escore clínico, no qual figuram três características (ausência de coriza, exsudato de orofaringe e hiperemia de orofaringe) correspondeu a uma sensibilidade de 45,6%, uma especificidade de 74,5% e uma likelihood ratio de 1,79 para a presença de faringoamigdalite estreptocócica. CONCLUSÃO: O quadro clínico não deve ser usado isoladamente para confirmar o episódio de faringoamigdalite estreptocócica por apresentar um baixo desempenho diagnóstico. É necessário aumentar a disponibilidade de testes laboratoriais, em especial o TALP, que permite o diagnóstico rápido...
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Faringite/diagnóstico , StreptococcusRESUMO
A Força Muscular Respiratória é uma ferramenta capaz de diagnosticar diferentes desordens. As equações de referência até hoje descritas consideram diferentes populações e metodologias. Entretanto, não há consenso quanto a qual equação é ideal para se utilizar. O objetivo deste estudo foi comparar e correlacionar valores medidos de pressões respiratórias máximas com aqueles previstos por equações descritas na literatura. A amostra foi de 90 indivíduos saudáveis de 6 a 12 anos. Foram realizadas antropometria, espirometria e manovacuometria. A comparação dos valores medidos e previstos diferiu significativamente, apresentando pressão inspiratória máxima (PImáx) média (80,65±26,78), no sexo masculino, maior que a prevista por Wilson et al. (67,40±5,65; p<0,001) e Schmidt et al. (70,69±21,70; p<0,05). Pressão expiratória máxima (PEmáx) masculina média (84,35±23,16) foi menor que a prevista por Domènech-Clar et al. (92,25±16,90; p<0,01) e maior que a prevista por Schmidt et al. (72,78±13,62; p<0,001). Pressão inspiratória máxima feminina média (76,14±26,08) foi maior que a prevista por Wilson et al. (57,96±6,04; p<0,001), Schmidt et al. (68,54±7,08; p<0,01) e Domènech-Clar et al. (67,61±11,17; p<0,01). Pressão expiratória máxima feminina média (74,55±20,05) foi maior que a prevista por Wilson et al. (66,65±9,55; p<0,001) e menor que a prevista por Domènech-Clar et al. (81,16±14,37; p<0,01). As correlações entre valores medidos e previstos foram de baixa a média magnitude (variação entre r=0,1 e 0,5), sendo significativas para o sexo masculino quando a PImáx foi correlacionada à prevista por Wilson et al. (p<0,01) e Domènech-Clar et al. (p<0,05). Já para o sexo feminino, ambas as correlações foram significativas (PImáx p<0,01; PEmáx p<0,05). Concluiu-se que as equações não conseguiram predizer os valores de pressões respiratórias máximas, reforçando a necessidade de novas equações de força muscular respiratória...
Respiratory Muscle Strength is an important tool to diagnose different disorders. Reference equations considered different populations and methodologies. However, there is no agreement on what is the ideal equation to use. The aim of this study was to compare and correlate the measured values of maximal respiratory pressures with those demonstrated by equations described in literature. The sample consisted of 90 healthy individuals aged from 6 to 12 years old. Anthropometric, spirometric and manometric measurements were performed. The comparison between measured and predicted values was significantly different, showing the mean male maximum inspiratory pressure (maxIP) (80.65±26.78) to be higher than that predicted by Wilson et al. (67.40±5.65, p<0.001) and Schmidt et al. (70.69±21.70, p<0.05). The mean male maximum expiratory pressure (maxEP) (84.35±23.16) was lower than the one predicted by Domènech-Clar et al. (92.25±16.90, p<0.01) and higher than the one predicted by Schmidt et al. (72.78±13.62 p<0.001). The mean of female individuals' maxIP (76.14±26.08) was higher than that predicted by Wilson et al. (57.96±6.04, p<0.001), Schmidt et al. (68.54±7.08, p<0.01), and Domènech-Clar et al. (67.61±11.17, p<0.01). The mean female maxEP (74.55±20.05) was higher than the ones predicted by Wilson et al. (66.65±9.55, p<0.001) and lower than the one predicted by Domènech-Clar et al. (81.16±14.37, p<0.01). The correlations between measured and predicted values were from low to medium magnitude (range r=0.1 to 0.5) being significant for males when maxIP was correlated with that predicted by Wilson et al. (p<0.01) and Domènech-Clar et al. (p<0.05). For females, both correlations were significant (maxIP p<0.01; maxEP p<0.05). It was concluded that the equations failed to predict the values of maximum respiratory pressures, reinforcing the need for new equations of respiratory muscle strength...
La Fuerza Muscular Respiratoria es una herramienta capaz de diagnosticar diferentes desórdenes. Las ecuaciones de referencia hasta hoy descritas consideran diferentes poblaciones y metodologías. Entre tanto, no hay consenso en cuanto a que ecuación es ideal para utilizar. El objetivo de este estudio fue comparar y correlacionar valores medidos de presiones respiratorias máximas con aquellos previstos por las ecuaciones descritas en la literatura. La muestra fue de 90 individuos sanos de 6 a 12 años. Fueron realizadas antropometría, espirometría y manovacuometría. La comparación de los valores medidos y previstos difirió significativamente, presentando presión inspiratoria máxima (PImáx) media (80,65±26,78) , en el sexo masculino, mayor que la prevista por Wilson et al. (67,40±5,65; p<0,001) y Schmidt et al. (70,69±21,70; p<0,05). Presión expiratoria máxima (PEmáx) masculina media (84,35±23,16) menor que la prevista por Domènech-Clar et al. (92,25±16,90; p<0,01) y mayor que Schmidt et al. (72,78±13,62; p<0,001). Presión inspiratoria máxima femenina media (76,14±26,08) mayor que la prevista por Wilson et al. (57,96±6,04; p<0,001), Schmidt et al. (68,54±7,08; p<0,01) y Domènech-Clar et al. (67,61±11,17; p<0,01). Presión expiratoria máxima femenina media (74,55±20,05) mayor que la prevista por Wilson et al. (66,65±9,55; p<0,001) y menor que Domènech-Clar et al. (81,16±14,37; p<0,01). Las correlaciones entre valores medidos y previstos fueron de baja a media magnitud (variación entre r=0,1 y 0,5) siendo significativas para el sexo masculino cuando la PImáx fue correlacionada a la prevista por Wilson et al. (p<0,01) y Domènech-Clar et al. (p<0,05). Para el sexo femenino, ambas correlaciones fueron significativas (PImáx p<0,01; PEmáx p<0,05). Se concluyó que las ecuaciones no consiguieron predecir los valores de presiones respiratorias máximas, reforzando la necesidad de nuevas ecuaciones de fuerza muscular respiratoria...
Assuntos
Humanos , Masculino , Feminino , Criança , Força Muscular , Valores de Referência , Músculos Respiratórios , Brasil , Espirometria , Estudantes , Ventilação Voluntária Máxima/fisiologiaRESUMO
Single BCG vaccination has been considered as a protective factor against asthma. However the effect of a second dose of BCG on the prevalence rate of asthma and asthma-allergic rhinitis-eczema comorbidity has not been studied exclusively among adolescents. In this ISAAC protocol-based cross sectional study we assessed the association between one single versus two doses of BCG among 2213 individuals aged 13-14 years old. We found no association between BCG revaccination and asthma, associated (OR = 0.68, 95% CI, 0.37-1.25) or not to allergic rhinitis and/or atopic eczema (OR = 1.07, 95% CI, 0.84-1.36).
Assuntos
Asma/prevenção & controle , Vacina BCG , Imunização Secundária , Adolescente , Asma/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Dermatite Atópica/epidemiologia , Dermatite Atópica/prevenção & controle , Humanos , Prevalência , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica Perene/prevenção & controle , Rinite Alérgica Sazonal/epidemiologia , Rinite Alérgica Sazonal/prevenção & controleRESUMO
O objetivo deste trabalho foi fazer um levantamento bibliográfico focalizando a pre- valência de sibilância em lactentes. A pesquisa foi limitada a estudos publicados no período de 1999 a 2010 em português, espanhol e inglês e incluídos nas bases de dados MEDLINE (PubMed) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), utilizando-se as palavras-chave infant, prevalence, wheezing, bronchospasm, and asthma. A síndrome sibilante é comum na infância, apresenta o início dos sintomas nos primeiros anos de vida e inclui diversos diagnósticos diferenciais. A determinação da sua prevalência bem como dos seus fatores predisponentes é de fundamental importância para o planejamento das ações educativas e de prevenção.
The objective of this study was to review the literature focusing the prevalence of wheezing in infancy. The search was limited to studies published between 1999 and 2010 in Portuguese, Spanish or English and included in the LfLACS and MEDLfNE da- tabases using the key-words infant, prevalence, wheezing, bronchospasm and asthma. The wheezing syndrome is common in childhood with the beginning of symptoms in the first years of life and including many differential diagnosis. The evaluation of its prevalence as well as of its predisposing factors is extremely important for planning educational and preventive actions.
Assuntos
Humanos , Lactente , Fatores de Risco , Sons Respiratórios , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
Este artigo, com base na apresentação do caso clínico de uma adolescente portadora de asma persistente associada a distúrbios psicoafetivos, procura comentar o atual modelo biotecnológico de atendimento que exclui a subjetividade do paciente. Discute, a partir do caso apresentado, as possíveis contribuições da escuta médica de orientação psicanalítica na condução de casos de pacientes portadores de asma não controlada.
This article. through the presentation of a clinical case of a teen-ager with persistent asthma associated to psycho-affective disorders attempts to discuss the current biotechnological model that excludes patients subjectivity and consider possible contributions of a medical practice under psychoanalytical theory orientation in the management of these uncontrolled asthmatic patients.
Assuntos
Humanos , Feminino , Adolescente , Asma/psicologia , Psicologia Clínica , Sintomas Afetivos/complicações , Psicologia do Adolescente , Psiquiatria do AdolescenteRESUMO
OBJECTIVES: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrollment in an asthma program. METHODS: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrollment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. RESULTS: In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). CONCLUSIONS: Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.